Sex
Ask Dr. Bob
Why do I get migraines during orgasm? And is it nobler to be a writer or a doctor?
I sometimes get severe headaches at orgasm. It is worrying my husband and me, too! Is there something wrong?
The first time I heard a patient complain about headaches during sex, I began asking questions about her marriage, thinking the problem was psychological and that she wanted a letter from her doctor excusing her from intimacy.
But the patient’s marriage was more solid than my medical skills. The woman not only enjoyed sex, she loved it. The problem wasn’t during all sex; it was limited to the moment of orgasm. My further faulty reasoning: If the problem wasn’t psychological, it must be mechanical. I questioned her about various positions. The woman blushed, then told me the most vivid details.
“Maybe you shouldn’t have your legs in the air, hang your head over the side of the bed and do it upside down,” I said. She went home with a new game plan: missionary position only. She returned in two weeks. The headaches were the same: severe throbbing occurring right at the onset of orgasm. They tended to last for 10 to 15 minutes and then resolve.
We reconsidered the psychological implications, searched for foreplay’s subliminal messages and even used the word-association method. Perhaps there was a hidden meaning in the phrase “pounding headache.” The woman left my office in tears, convinced that she was screwy in the head and worried that she had some unconscious disdain for sex, her husband and the world in general.
Mea culpa. A thousand apologies to that patient. A couple of years after that encounter I came across a journal article describing orgasmic migraine. The headaches weren’t psychological or mechanical, but rather a physiological disorder complete with a frequent family history.
Orgasmic migraine is now a well-recognized entity of high-intensity, often throbbing headache that begins during sexual arousal, both with and without a partner, culminates in a splitting headache at orgasm and then relatively quickly subsides. It is seldom associated with the other symptoms of migraine such as nausea, vomiting and photophobia. And it is rarely associated with any serious underlying pathology such as an aneurysm or arteriovenous malformation of the brain. It is more common in men than women. It tends to occur in episodes lasting a few weeks to a few months, and then subsides only to recur without specific provocation.
I suspect that many people have had a paroxysm of coughing during which they have a sudden sharp headache that lasts a few seconds. This is a migraine variant referred to as “cough headache.” Similarly, there are those who get bad headaches during exertion. The mechanism is probably the same. In some respects the orgasmic migraine is similar to these forms of benign vascular headache. The prevailing theory suggests that migraine is caused by neurogenic inflammation of brain-stem structures, especially the portion that controls the nerves and vasculature of the face.
The headaches often can be treated preventively with beta blockers and calcium-channel blockers. The results are good; in any case, the headaches tend to resolve on their own, regardless of the treatment.
The point to remember: The headache is benign and has no Freudian implication regarding sexuality. So let your lover, not your headache, get you down.
I just stumbled onto your column last week and found it to be very interesting and well-written. My question to you is not so much a professional question as it is a “question of profession.”
Ever since I was in high school, I have been torn between two different fields: writing fiction and becoming a doctor. Can you see where this is going? It seems that the response I usually hear is, “Think carefully — for it is horrible to be an artist trapped in a doctor’s coat.” But I see that you are both a novelist and a doctor. Do you feel that you have made great sacrifices in your writing to be a physician, or vice versa?
I graduated college in psychology, but am now a technical writer at 24. If I were to become a doctor, I would love to work in psychiatry, neurology or sleep research. If I were to be a writer, I would love to write science-fiction novels. I’m sure it is possible to do both — but how much time would I have left over to live life itself?
If you have any time, your input, advice or even amusing anecdotes would be tremendously appreciated. I feel that this vacillation is paralyzing my motivation altogether. I am driven toward each career, and yet feel that I must make a choice or forever wallow in compromise as I am doing now.
The most overlooked consideration in giving career advice is the passage of time. People change. So the longer the professional training period, the greater should be your certainty, which is an impossible task given that what sounds great at 24 might seem like a terrible mistake at 50.
Unlike many trades, medicine allows little lateral transfer of skills (although perhaps surgeons can become butchers). Sure, you can switch from research to practice to hospital administration to medical journalism, but the training is much more confining than studying law, journalism or art. Before making any decision, take some time for introspection. Imagine yourself at various ages. Talk to people in different phases of the profession.
More than ever before, being a physician requires a commitment to personal values that may not be adequately rewarded by the general public. Spending more time with your patients won’t endear you to your clinic administrator.
But then, slaving over a sentence won’t necessarily bring better reviews or book sales. The commercial aspects of medicine and fiction writing are somewhat similar. Unless you are a super-specialist or a blockbuster writer, your income will not compare with that of MBAs or day traders. In both medicine and writing, pursuit of excellence is its own reward.
Regardless of managed care, future care or whatever else is coming down the pike, the thing about medicine that will never disappear is its wonderful sense of drama. Life and death are immune to the vagaries of HMOs. If you really like personal engagement, the nitty-gritty of heartbreak, grief and joy, there is no more rewarding profession. But you must see this as a calling, a commitment stronger than any sense of a life sacrificed or outside opportunity missed. More than ever, going into medicine — to be a satisfactory choice — is like choosing to be a man of the cloth.
This is the tricky part about career decisions — knowing what, for you, is the best balance between internal and external rewards. Much of the dissatisfaction felt by today’s physicians stems from their comparing their own salary, praise, status and working conditions with those of business tycoons, software developers and mega-lawyers. Comparison tends to generate envy and bitterness. What you are not privy to at your age is the converse, the underlying sense of insubstantiality that I hear and see among so many of the so-called successful business folk.
Writers have a similar dilemma. The best literature is seldom recognized in today’s celebrity- and bottom-line-driven publishing world. Writers can take comfort that they are pursuing their art. But, by the same argument, doctors, even though bombarded by a battery of social forces, can still feel pleasure in their individual patient relationships and accomplishments.
Now for a very politically incorrect comment: Above all, what you need to decide is whether you have a true talent for writing. Without talent, most are best suited for a structured work life, one in which they are not constantly challenged with a blank page or canvas. Routine is God’s gift to the unimaginative. Conversely, the artistically gifted tend to be restless, constantly seeking new form and structure in their work.
My writer friends, like myself, might feel envy at the stack of Stephen King or Tom Clancy books in front of Office Depot and K-Mart, but that isn’t why we write fiction. The rewards are internal. Even if I were able to figure out a formula for mega-success, I would abandon it for the next book. For me, life is about exploration, not repetition. Which is why I would have made a very poor general practitioner. And why, during this age of brain speculation, neurology has been so much fun.
When I was considering taking up novel writing, I had lunch with a local psychiatrist who was also a novelist. His sage comment: “When I am at a medical meeting, I am glad I am a writer. When I am at a writers’ conference, I say, ‘Thank God I’m a doctor.’”
Do both and don’t look back.
Robert Burton, M.D., is the former chief of neurology at Mount Zion-UCSF Hospital and the author of "On Being Certain: Believing You Are Right Even When You're Not." His column, "Mind Reader," appears regularly in Salon. More Robert Burton.
Taxing strip clubs for rape
Politicians are holding adult entertainment venues responsible for funding sexual assault services
(Credit: iStockphoto/wragg) It used to be that strip clubs were merely blamed for society’s ills. Now they’re actually being charged for it.
In recent years, measures have been introduced in Georgia, Pennsylvania, Texas, Illinois and, most recently, California to apply special taxes to strip clubs — specifically to fund sexual assault services. Now, even if you aren’t inclined to view erotic entertainment as the source of all evil, this might seem an appropriate aim — who wants to argue against additional support for rape survivors? It would seem even more so when you consider politicians’ and activists’ repeated claims of solid scientific evidence showing a link between strip clubs — specifically those that sell alcohol — and sexual violence.
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory.
Massage therapists rubbed wrong by sex talk
A Jennifer Love Hewitt show and the Travolta allegations have masseuses tired of being confused for sex workers
(Credit: iStockphoto/sybanto) Joe, a licensed massage therapist, knows what it’s like having a famous client who expects something extra. He had an Academy Award-winning actor begin gyrating on his massage table before raising his hips in the air to show off his erection. “He was hoping that I would play with him in some shape or form,” he says.
Needless to say, Joe isn’t surprised by allegations by two masseurs that John Travolta got handsy during massages. (Travolta’s attorney has denied all the allegations, and called them “ridiculous.”) “It happens all the time,” he says, and not just with celebrity clients. He frequently encounters men who try to fondle him, usually while he’s working on their glutes or lower back and their hand happens to be level with his crotch. “They think they’re so original, but they’re all so much the same,” Joe says, his voice rising. “They all use the same tactics, the same body movements, the same gyrations and grinding my table, the [heavy] breathing.”
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory.
A night at the vibrator museum
Early vibrators were hand-cranked, two-person jobs -- and prescribed by doctors. How far we've come since then
(Credit: Antique Vibrator Museum) I can now say that I’ve used a turn-of-the-century vibrator — on my hand, but still.
The silver, hand-cranked contraption is usually kept behind glass at Good Vibrations’ Antique Vibrator Museum in San Francisco — but staff sexologist Carol Queen made a rare exception. “This is very special,” she whispered, unlocking the case and carefully pulling out Dr. Johansen’s Auto Vibrator, a relic from 1904. The “auto” part is not so much: It was a two-person job, with her having to crank the device’s handle to get it thrumming. Pressing my finger tips to its inch-wide circular platform of pleasure, I was pleasantly surprised by its power.
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory.
Maggie Gyllenhaal on sexual liberation
The beloved indie star tells Salon about her "vibrator movie" and why she loves playing transgressive women
Maggie Gyllenhaal (Credit: Reuters/Mark Blinch) When I met Maggie Gyllenhaal about six weeks ago, she was enormously and gloriously pregnant, stretching out on a sofa with her shoes off and feet up in a Manhattan office building. (Since that time, Gyllenhaal and husband Peter Sarsgaard have welcomed their second daughter, Gloria Ray, to the world.) We were there to talk about “Hysteria,” the charming, lightweight feminist farce from director Tanya Wexler that explores a key event in the history of female sexuality: the invention of the vibrator by Mortimer Granville, a Victorian doctor who was seeking to cure the mysterious “female malady” that lends the movie its title.
Continue Reading CloseMother-daughter sexperts
Susie Bright and her daughter, Aretha, make parental talks about sex look easy -- and fun
Most parents loathe talking to their kids about the birds and the bees, let alone pubic hair grooming, faked orgasms and “water sports” — but most parents are not legendary “sexpert” Susie Bright.
Better than talking about these things, she penned an advice column in 2009 with her daughter, Aretha, then 19, for the ladyblog Jezebel. Their answers to questions about everything from porn to Paxil were unflinching but playful, and at times controversial. Now the pair have collected those columns into a new e-book, “Mother/Daughter Sex Advice.” Together, they read as an irreverent version of “Our Bodies, Ourselves” for the Internet age. The mother-daughter team also reflect on what the experience of writing the column was like, and it turns out it wasn’t as weird as many would think: For the most part, it was just a continuation of conversations they had been having throughout Aretha’s life.
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Tracy Clark-Flory is a staff writer at Salon. Follow @tracyclarkflory on Twitter. More Tracy Clark-Flory.
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